Nasal polyps

 

What is a nasal polyp?

A polyp is a swelling of the lining of the nose, which is usually due to inflammation of the lining of the nose. Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.

Nasal polyps aren’t painful to the touch.

Causes

Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses, which drain into the side wall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known.

Nasal polyps are linked to allergic rhinitis, asthma, aspirin allergy, sinus infections, acute and chronicinfections, something stuck in the nose, and cystic fibrosis. But many times the cause is unknown. Sometimes, people get them before they develop asthma or sinusitis.

Unlike polyps that form in the colon or bladder, nasal ones are rarely cancer. Experts think that long-term inflammation causes them or that they run in families.

Conditions associated with polyps

They commonly occur in more general diseases such as late onset asthma in an adult patient, aspirin intolerance or cystic fibrosis.

Late onset asthma rather than childhood asthma is associated with nasal polyps. Of the patients with polyps 20% to 40% will have coexisting asthma. Although nasal allergy is present in some cases, more than two thirds of the patients show no evidence of systemic allergic disease. However, 90% of nasal polyps have eosinophilia (inflammatory cells present which are associated with allergy).

Aspirin hypersensitivity is not an allergic reaction but an alteration in prostaglandin production. Asthma, aspirin sensitivity and nasal polyps together are a well-recognised subgroup in 8% of polyp patients. These polyps tend to recur more than in other conditions.

Nasal polyps are rare in children between the ages of two and 10 years. If found in children cystic fibrosis should be excluded

Symptoms

 

Most people with nasal polyps have a runny nose, sneezing, and postnasal drip. About 75% have problems with their sense of smell.

Many people also have wheezing, sinus infections, and sensitivity to fumes, odors, dusts, and chemicals. It’s less common, but some people with nasal polyps also have a severe allergy to aspirin and reaction to yellow dyes. If you know you have that allergy, ask your doctor to check for nasal polyps.

Nasal polyps make you more likely to have long-term (chronic) sinusitis. Large ones can even change the shape of your nose.

Who Gets Them?

Anyone can, but they’re most common in adults over age 40 and are twice as likely to affect men as women. Children under age 10 rarely get them. If they do, a doctor will check for signs of cystic fibrosis.

Nasal polyps are linked to allergic rhinitisasthmaaspirin allergy, sinus infections, acute and chronic infections, something stuck in the nose, and cystic fibrosis. But many times the cause is unknown. Sometimes, people get them before they develop asthma or sinusitis.

Some experts think that symptoms of allergies — including runny nose, sneezing, and itching — make some people more likely to get nasal polyps. But the allergy connection is controversial. Other researchers think that sinus infections are to blame.

Treatment

The first step to determining the appropriate nasal polyps treatment is to be evaluated by an experienced sinus surgeon. The Doctor will examine you and may recommend that you have a CT scan of your sinuses taken. This will allow to visualize the extent of sinuses involved, and also if there are any structural abnormalities (such as a deviated septum) or another condition (such as chronic sinusitis) that’s aggravating your nasal polyps.

Conservative treatment options are always tried first and may include the following:

  • Nasal steroid sprays– used to shrink polyps, help clear blocked nasal passages and temporarily alleviate runny nose symptoms
  • Antihistamines– used to help reduce symptoms like runny nose while decreasing inflammation, particularly if inflammation is caused by allergies
  • Antibiotics– used to help treat polyps caused by a bacterial sinus infection
  • Oral steroid pills– used to reduce swelling and other symptoms, but they shouldn’t be taken long-term because of possible side effects

 

Nasal polyps are known to shrink when nasal sprays or drops containing nasal steroids are used. Stronger steroids in drop form can be used but should only be used with care and limited to short courses because some is absorbed into the body.

Polyps respond and shrink using drops or sprays in up to 80% of people. New nasal steroid sprays can be taken to control symptoms for many years as very little is absorbed into the body and they can work well, but many take up to six weeks of treatment before their full effect can be felt.

Steroids in tablet form can provide good relief of symptoms but the effects are short-lived and they are used sparingly because of concerns about side effects. If medicines don’t work then surgery is needed.

Nasal washes can be done to reduce the mucus build up inside the nasal cavity.They improve the quality of life for the patient but do not shrink the polyps.

What does nasal polyp removal surgery involve?

In cases where conservative treatments don’t provide effective relief, nasal polyps removal surgery may be considered.

Functional Endoscopic Sinus Surgery (FESS) is performed using an endoscope – a tube with a tiny camera that gives your doctor a detailed view inside your nose and sinuses. During this procedure, the polyps and any other problematic tissue can be precisely removed. Special instruments are passed through your nostrils to perform the corrections, so no incisions will need to be made to your face. This surgery enlarges the drainage pathways of your sinuses and fixes any other issues interfering with drainage, thus preventing a future build-up of mucus.

Balloon Sinuplasty: A tiny balloon catheter is inserted through your nostril and inflated in your sinus passageway. The passageway is gently opened and widened to restore normal sinus drainage and function, and the balloon is then deflated and carefully removed. This surgery is done along with FESS to open the sinuses atraumatically.

How successful are surgical options?

In many cases, nasal polyps removal can be very successful and lead to a great reduction in symptoms. However, if your nasal polyps are caused by a genetic or allergic issue, the polyps may re-emerge and require repeat treatments. Under these circumstances, nasal polyp surgery can provide relief, but it may not be permanent without additional treatment in the future.

Local medical treatment is often still needed using anti-inflammatory sprays or drops.

The Role of allergy Testing and Immunotherapy

Considering that the main cause for Polyp formation is Allergy, it would be helpful to get a complete Allergy Test done following polyp surgery. This is best done by SKIN PRICK TEST which is recommended by World Allergy Organisation, World Health Organisation to be the GOLD Standard of Allergy Testing.

At ALLERGYDOC, we do an allergy test for 110 allergens and help identify your allergies. Allergic foods can be avoided from the diet, Immunotherapy is started for inhaled allergens.

Subcutaneous immunotherapy or allergy vaccinations have been in vogue for more than 100 years. This is the only way known to change the course of Allergic disease and have a long term impact.

Noise-induced hearing loss

What is noise-induced hearing loss?

Every day, we experience sound in our environment, such as the sounds from television and radio, household appliances, and traffic. Normally, these sounds are at safe levels that don’t damage our hearing. But sounds can be harmful when they are too much loud, even for a brief time, or when they are both loud and long-lasting. These sounds can damage sensitive structures in the inner ear and cause noise-induced hearing loss (NIHL).
NIHL can be immediate or it can take a long time to be diagnose. It can be temporary or permanent, and it can affect one ear or both ears. Even if you can’t tell that you are damaging your hearing, you could have trouble hearing in the future, such as not being able to understand other people what are they talking, especially on the phone or in a noisy room. Regardless of how it might affect you, one thing is certain: noise-induced hearing loss is something you can prevent.

What are the of causes NIHL?

Noise –induced hearing loss can be caused by a one-time exposure to an intense “impulse” sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a woodworking shop.
Recreational activities that can put you at risk for NIHL include target shooting and hunting, snowmobile riding, listening to MP3 players at high volume through earbuds or headphones, playing in a band, and attending loud concerts. Harmful noises at home may come from sources including lawnmowers, leaf blowers, and woodworking tools.
Sound is measured in units called decibels. Sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss. However, long or repeated exposure to sounds at or above 85 decibels can cause hearing loss. The louder the sound, the shorter the amount of time it takes for NIHL to happen.

Here are the average decibel ratings of some familiar sounds:
• The humming of a refrigerator
45 decibels
• Normal conversation
60 decibels
• Noise from heavy city traffic
85 decibels
• Motorbikes
95 decibels
• MP3 player at maximum volume
105 decibels
• Sirens
120 decibels
• Firecrackers and firearms
150 decibels
Your distance from the source of the sound and the length of time you are exposed to the sound are also important factors in protecting your hearing. A good rule of thumb is to avoid noises that are too loud, too close, or last too long.

Allergy Testing

• Allergy types
• Purpose
• How to prepare
• Testing
• Risks
• Results

Overview

An allergy test is an exam performed by a trained allergy specialist to determine if your body has an allergic reaction to a known substance. The exam can be in the form of a blood test, a skin test, or an elimination diet.
Allergies occur when your immune system, which is your body’s natural defense, overreacts to something in your environment. For example, pollen, which is normally harmless, can cause your body to overreact. This overreaction can lead to:
• a runny nose
• sneezing
• blocked sinuses
• itchy, watery eyes

ALLERGY TYPES

Types of allergens

Allergens are substances that can cause an allergic reaction. There are three primary types of allergens:
• Inhaled allergens affect the body when they come in contact with the lungs or membranes of the nostrils or throat. Pollen is the most common inhaled allergen.
• Ingested allergens are present in certain foods, such as peanuts, soy, and seafood.
• Contact allergens must come in contact with your skin to produce a reaction. An example of a reaction from a contact allergen is the rash and itching caused by poison ivy.
Allergy tests involve exposing you to a very small amount of a particular allergen and recording the reaction.
Insect sting allergy tests »

PURPOSE

Why allergy testing is performed

Allergies affect more than 50 million people living in the USA, according to the American College of Allergy, Asthma, and Immunology. Inhaled allergens are by far the most common type. Seasonal allergies and hay fever, which is an allergic response to pollen, affect more than 40 million Americans.
The World Allergy Organization estimates that asthma is responsible for 250,000 deaths annually. These deaths can be avoided with proper allergy care, as asthma is considered an allergic disease process.
Allergy testing can determine which particular pollens, molds, or other substances you’re allergic to. You may need medication to treat your allergies. Alternatively, you can try to avoid your allergy triggers.
HOW TO PREPARE

How to prepare for allergy testing

Before your allergy test, your doctor will ask you about your lifestyle, family history, and more.
They’ll most likely tell you to stop taking the following medications before your allergy test because they can affect the test results:
• prescription and over-the-counter antihistamines
• certain heartburn treatment medications, such as famotidine (Pepcid)
• anti-IgE monoclonal antibody asthma treatment, omalizumab (Xolair)
• benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan)
• tricyclic antidepressants, such as amitriptyline (Elavil)
TESTING

How allergy testing is performed

An allergy test may involve either a skin test or a blood test. You may have to go on an elimination diet if your doctor thinks you might have a food allergy.

Skin prick allergy to find out kind of allergy

Skin tests
Skin tests are used to identify numerous potential allergens. This includes airborne, food-related, and contact allergens. The three types of skin tests are skin prick , intradermal, and patch tests.
Your doctor will typically try a SKIN PRICK test first. During this test, an allergen is placed in liquid, then that liquid is placed on a section of your skin with a special tool that lightly punctures the allergen into the skin’s surface. You’ll be closely monitored to see how your skin reacts to the foreign substance. If there’s localized redness, swelling, elevation, or itchiness of the skin over the test site, you’re allergic to that specific allergen.
Skin Prick Testing is the GOLD STANDARD of allergy testing according to the World Allergy Organisation and World Health Organisation.
If the scratch test is inconclusive, your doctor may order an intradermal skin test. This test requires injecting a tiny amount of allergen into the dermis layer of your skin. Again, your doctor will monitor your reaction.
Another form of skin test is the patch test (T.R.U.E. TEST). This involves using adhesive patches loaded with suspected allergens and placing these patches on your skin. The patches will remain on your body after you leave your doctor’s office. The patches are then reviewed at 48 hours after application and again at 72 to 96 hours after application.

Blood tests
If there’s a chance you’ll have a severe allergic reaction to a skin test, your doctor may call for a blood test. The blood is tested in a laboratory for the presence of antibodies that fight specific allergens. This test, called ImmunoCAP, is successful in detecting IgE antibodies to major allergens.

Elimination diet
An elimination diet may help your doctor determine which foods are causing you to have an allergic reaction. It entails removing certain foods from your diet and later adding them back in. Your reactions will help determine which foods cause problems.
RISKS

The risks of allergy testing

Allergy tests may result in mild itching, redness, and swelling of the skin. Sometimes, small bumps called wheals appear on the skin. These symptoms often clear up within hours but may last for a few days. Mild topical steroid creams can alleviate these symptoms.
On rare occasions, allergy tests produce an immediate, severe allergic reaction that requires medical attention. That’s why allergy tests should be conducted in an office that has adequate medications and equipment, including epinephrine to treat anaphylaxis, which is a potentially life-threatening acute allergic reaction.
Call your doctor right away if you develop a severe reaction right after you leave the doctor’s office.

RESULTS

After allergy testing

Once your doctor has determined which allergens are causing your symptoms, you can work together to come up with a plan for avoiding them. Your doctor can also suggest medications that may ease your symptoms.

Foreign Body in the Nose


• Common items
• Symptoms
• Diagnosis
• Treatment
• Prevention

The dangers of your child putting objects in their nose or mouth

Children are naturally curious and often wonder how things work. Usually, they display this curiosity by asking questions, or by exploring the world around them.
One of the dangers that can occur as a result of this curiosity is that your child may place foreign objects into their mouth, nose, or ears. While often harmless, this can create a choking hazard and put your child in danger of serious injuries or infections.
A foreign body in the nose means that an object is present in the nose when it’s not naturally supposed to be there. Children under the age of five often have this issue. But it’s not uncommon for older children to place foreign objects in their nostrils.

COMMON ITEMS
Common items that may end up in your child’s nose
Common items that children put in their noses include:
• small toys
• pieces of eraser
• tissue
• clay (used for arts and crafts)
• food
• pebbles
• dirt
• paired disc magnets
• button batteries
Button batteries, such as those found in a watch, are of particular concern. They can cause serious injury to the nasal passage in as little as four hours. Paired disc magnets that are sometimes used to attach earrings or a nose ring can also damage tissue. This would typically occur over a few weeks.
Children often put these objects into their noses out of curiosity, or because they’re mimicking other children. However, foreign objects can also go into the nose while your child is sleeping, or when they try to sniff or smell an object.

SYMPTOMS

What are the signs of a foreign body in the nose?
You may suspect that your child has put something in their nose, but are unable to see it when you look up their nose. Foreign objects in the nose may cause other signs.

Nasal drainage

A foreign body in the nostril will cause nasal drainage. This drainage may be clear, gray, or bloody. Nasal drainage with a bad odor may be a sign of an infection. Nasal discharge from one side of the nose, is usually a suspicious sign and the ENT doctor will look carefully for forgotten Foreign Bodies.


Breathing difficulty

Your child may have difficulty breathing through the affected nostril. This occurs when the object clogs the nostril, making it difficult for air to move through the nasal passage.
Your child may make whistling noises when breathing through their nose. A stuck object could cause this noise.
DIAGNOSIS
Diagnosing a foreign body in the nose
Make an appointment with your child’s ENT doctor if you suspect your child has something in their nose but you can’t see it. At the appointment, the doctor will look into your child’s nose with a lighted instrument.
Your child’s doctor may swab nasal discharge and have it tested for the presence of bacteria.

TREATMENT

How to remove the object

Keep calm if you discover an object in your child’s nose. Your child may begin to panic if they see you panicking.
The only treatment for this condition is to remove the foreign object from the nostril. In some cases, blowing the nose gently may be all that’s necessary to treat this condition. Here are some tips for removing the object:
• DO not try removing the object with tweezers.Tweezers may push smaller objects farther up the nose.
• Avoid sticking cotton swabs or your fingers into your child’s nose. This can also push the object farther into the nose.
• Stop your child from sniffing. Sniffing could cause the object to move farther up their nose and pose a choking hazard. Encourage your child to breathe through their mouth until the object is removed.
• Go to your nearest hospital emergency room or ENT Specialist They’ll have other instruments that can remove the object. These include instruments that will help them grasp or scoop out the object. They also have machines that can suction out the object.
Your child’s doctor may prescribe antibiotics or nasal drops to treat or prevent an infection.

PREVENTION

How do I prevent my child from putting foreign objects in their nose?

Even with careful supervision, it can be difficult to prevent your child from putting foreign objects in their nose, ears, or mouth. Sometimes children will misbehave for attention. For this reason, never yell at your child when you catch them putting things in their nose.
Gently explain to your child how noses function, and why it’s a bad idea to put things in their nose. Have this conversation every time you catch your child trying to put things in their nose.

Thyroid surgery

Surgery is the recommended treatment for various disorders of the thyroid gland . these may include one of the following :
. large thyroid or multi nodular goiter
. solitary nodule thyroid adenoma
. thyroid cancer
. graves disease
. recurrent thyroid cyst
. where the type of nodules is unclear

It is important that your surgery is performed by specialist who regularly performs thyroid operations. Do not hesitate to ask your surgeon any surgery related query, such as the post surgery complications as well as the benefits of surgery.
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Some can be precancerous. Even benign nodules can cause problems if they grow large enough to obstruct the throat, or they stimulate the thyroid to overproduce hormones. Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. It is referred to as a goiter. Like large nodules, goiters can block the throat and interfere with eating , speaking and breathing.

Types of thyroid surgery
There are several types of thyroid surgery but common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

Lobectomy
sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, a doctor will only remove one of the two lobes. The part left behind should retain some or all of its function.
Subtotal thyroidectomy
A subtotal thyroidectomy removes the thyroid gland but leaves behind a small amount of thyroid tissue. This preserves some thyroid function. Many individuals who undergo this type of surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormones. This is easily treated with daily hormone supplements.
Total thyroidectomy
A total thyroidectomy removes the entire thyroid and the thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland, or when cancer is present.

Thyroid Function Test

Thyroid function tests are used to measure how well
your thyroid gland is working. Available tests including
T3, T3RU, T4 and TSH. The thyroid is a small gland which
is located in the lower-part in your neck. It regulates the
many process of our body, such as metabolism, energy
generation, and mood.


Thyroid produces two major hormones in our body


. triiodothyronine

. thyroxine

If your thyroid gland doesn’t produce enough of these
hormones, you may experience symptoms such as
weight gain, lack of energy and depression. This
condition is called hypothyroidism.

In against situation if our thyroid gland produces too
many hormones, you may experience weight loss, high
levels of anxiety, tremors & a sense of being on a high.
This condition is called hyperthyroidism.

A doctor is who is actually concerned about your thyroid
treatment will order broad screening tests, such as the
T4 or the thyroid-stimulating hormone(TSH) test.